Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions

High Blood Pressure

Health information brought to you byBlue Cross Blue Shield of Massachusetts

"Something wrong? Yeah. It's just too bad you don't know what it is…"

It's unfortunate that this line written by Oscar nominated writer and director of the "Boyz in the Hood", is a reality for so many United States (U.S.) adults. But for over 50% of African American men and women this is not a movie, it's real life. John Singleton, the famed director succumbed to the complications of high blood pressure and died from a massive stroke, he was only 51 years old. Too many people in communities of color do not know they have high blood pressure, also called hypertension. Singleton was the first African American and youngest filmmaker to be nominated for an Academy Award for best director. He had so much more to contribute; his early death could have been prevented.  

We want to help you to understand hypertension and what can be done to manage or prevent it for yourself and your family. Hypertension is a chronic disorder of consistent high blood pressure with ranges above normal (see chart). The Center for Disease Control (CDC) states an astounding statistic, that half of all United States (U.S.) adults have high blood pressure. Only 1 in 4 adults have high blood pressure under control. This means 3 in 4 U.S. Adults with high blood pressure or a staggering 75% do not have it under control. Could that be you? Maybe you don't even know.

High blood pressure develops and increases slowly over time; the signs and symptoms that would get your attention do not occur until blood pressure ranges are extreme, possibly resulting in hospitalization and/or death; this is why it's often referred to as the silent killer. "You can't feel your blood pressure, so you really need to have it checked," states Dr. Mark Friedberg, an internal medicine physician at Mass General Hospital and Senior Vice President of Performance Measurement and Improvement at Blue Cross Blue Shield of Massachusetts. However some people whose blood pressure is extremely high may experience symptoms such as severe headaches, chest pain, dizziness, difficulty breathing, nausea, confusion, buzzing in the ears, nosebleeds or other symptoms. Over time, high blood pressure can cause damage to your heart, brain and kidneys. In 2021, the CDC stated that over 691,000 deaths in the U.S. Were primarily caused by hypertension (high blood pressure) or its complications. These numbers emphasize high blood pressure is truly a silent public health crisis.

What is blood pressure? 

Each time your heart beats, it pumps blood throughout your body and through your arteries. The pressure your blood puts on the arteries while circulating in the body is your blood pressure.

How can you find out what your blood pressure numbers are?     

It is a routine and painless measurement collected during a doctor's visit. Your local pharmacy can also measure your blood pressure. According to Dr. Friedberg, "The best way to prevent problems is to make sure your blood pressure is checked regularly (at least once a year) by a medical professional. It's important!"

How is it measured?

When you have your blood pressure checked, the results will include two numbers. The top number is your systolic pressure, the pressure your heart exerts while pumping blood. The bottom number is your diastolic pressure, the pressure your heart exerts when at rest between beats. Blood pressure is measured using both numbers, the systolic pressure followed by the diastolic pressure measured in units of milliliters of mercury (mm Hg).

What is normal blood pressure?

According to the American College of Cardiology and American Heart Association (AHA) if the first number called systolic blood pressure is less than 120 mm Hg, and the second number called diastolic blood pressure: is less than 80 mm Hg, that is considered a normal blood pressure. Each time you have your blood pressure checked, the results will include two numbers and your numbers will fall into one of these categories. For example, 112/73 mm Hg or "112 over 73" is considered a normal blood pressure.

American Heart Association

What if it is higher?

The first stage of hypertension starts when the first number systolic is between 130-139, and/or the second number diastolic, is between 80-89. The second stage of hypertension is indicated when the first number systolic is 140 or higher and/or when the second number diastolic is 90 or higher.

Importantly, both the CDC and the AHA report the rate of hypertension as higher in non-Hispanic black adults (56%) than in non-Hispanic white adults (48%), Asian adults (46%), or Hispanic adults (39%). Black people develop hypertension earlier in life and have higher rates of more severe high blood pressure ranges than other ethnic groups.

Dr. Ruth-Alma Turkson-Orcan, Nurse Practitioner and Researcher, Beth Israel Deaconess Medical Centers

The good news is that high blood pressure can be prevented, managed and controlled. There are many initiatives to help people with an early hypertension diagnosis as well as those individuals who struggle to control more acute high blood pressure. Dr. Ruth-Alma Turkson-Orcan, Nurse Practitioner and Researcher with the Beth Israel Deaconess Medical Centers encourages people to reframe how we think and talk about hypertension. "Think of it more as a management versus a treatment or cure…sticking with the meds, checking blood pressures at home is really the key to getting to the numbers at your target goal along with your provider."

It's important to recognize the risk factors that impact you in order to address the ones that can be controlled and be mindful about those you cannot. This is especially important for individuals with families and teaching them preventative habits, early.

What are the risk factors for hypertension?

There are two kinds, 1) risk factors that are beyond your control and 2) risk factors that can be controlled to help mitigate the severity or possibly even prevent hypertension.

1. There are fixed risk factors that you cannot change or control, but should be aware of.

• Family historyAccording to Dr.Friedberg, "If your parents had high blood pressure, there's a good chance you might get it," he said. "Most patients require medication, and it's not because of anything they did or didn't do. People shouldn't feel guilty or ashamed about having high blood pressure."

• AgeThe older we get the less elastic and flexible our blood vessels become making the pressure of the blood pumping more intense.

• GenderMen are more likely to develop high blood pressure in their early years, before age 60. Women are more likely to develop high blood pressure later, age 60 and older due to hormonal decreases in estrogen from menopause.

• RaceAfrican Americans not only have higher incidence rates of high blood pressure among all ethnic groups, they have a higher rate of the severity. It is not because someone is Black or Hispanic alone that they are at higher risk for high blood pressure, but other systemic factors like structural racism that contribute to this health inequity.   

2. There are several risk factor areas where you can work to control high blood pressure and create better habits for yourself. And, possibly even prevent high blood pressure from starting. 

• DietA focus on making healthy food choices can be a powerful first step to managing high blood pressure. Reduce salt and sugar from your diet. People who suffer from diabetes are also at a higher risk for high blood pressure. 12% of African Americans have diabetes, a chronic health condition that requires close monitoring. Diabetes directly affects how the body can successfully convert food into energy. If your body does not have enough energy, it affects how your body functions including major organs like the heart, brain and kidneys. 

• Alcohol consumptionRegular use of alcohol can lead to high blood pressure. The American Heart Association (AHA) recommends that if you do consume alcohol that you do so responsibly. Alcohol consumption increases dehydration a major contributor to elevated blood pressure. The CDC recommends increasing water consumption instead. People with high blood pressure should attempt to drink 8 – 15 cups of water per day, based upon their thirst.

• CholesterolIt's important to note more than half of adults with high blood pressure have high (LDL) cholesterol. Having too much cholesterol can create plaque in your arteries causing arteries to become stiff and narrow, increasing your blood pressure. 60% of individuals with high blood pressure also have high cholesterol. Your cholesterol levels can be managed with vigilance and support from your medical team.

• ExerciseDaily activity is recommended. Walking and/or taking classes at your local gym, local Y, or utilizing other fitness centers will prevent large fluctuations in weight. Preventing obesity is crucial. Review your health insurance coverage policy as many insurers offer incentives and discounts. Health insurance plans like those offered by Blue Cross Blue Shield of Massachusetts have made it a priority to promote health and wellness. In fact, yearly wellness visits are covered at $0 cost, these include routine screenings for many chronic illnesses like high blood pressure. Many of their members are eligible up to $300 in fitness and weight-loss reimbursements including health club membership and classes with weight-loss programs like WW (formerly known as Weight Watchers®) to name a few. Check your health insurance to review your benefits.   

In support of the broader community, Blue Cross has served as Bluebikes' title sponsor, since May 2018, helping to enhance access to the public bike share system in Greater Boston that serves as a safe and sustainable public transportation option and also helps communities stay active in an affordable way.

Dr. Leonor Fernandez, Health Equity Medical Director, Beth Israel Lahey Health

• TobaccoSmoking/vaping consumption damages and weakens blood vessels. It not only greatly increases your risk of high blood pressure but also heart disease: like a heart attack and stroke.

• StressWhile some moderate stress is ok, too much stress can increase blood pressure. The ability to negotiate stress positively directly affects our health outcomes. Our bodies physically respond to short-lived stress with an increase in heart rate, constriction of blood vessels and a temporary increase in blood pressure. However, chronic stress or long-term stress affects the physical and mental body. The path to reducing stress whether short-term or chronic is stress management. Dr. Leonor Fernandez, Health Equity Medical Director at Beth Israel Lahey Health (BILH) agrees, "we live in a stressful world." Physical exercise and staying socially connected to friends and family helps. Building a resilient mind is the foundation to creating a healthier body. 

A Call To Action

In 2020, then U.S. Surgeon General, Dr. Jerome Adams issued a call to action by highlighting hypertension as public health crisis. Dr. Adams advocated to take a team approach, provider, community and patient all working together.

Cecilia Flores-Rodríguez, PhD ,Senior Program Manager for Provider Performance and Equity, Blue Cross Blue Shield of Massachusetts

Blue Cross is answering that call to action. For Cecilia Flores-Rodríguez, PhD, Senior Program Manager for Provider Performance and Equity, "Blue Cross takes pride in its deep commitment to address health equity through its collaborative partnership with provider organizations as they implement hypertension initiatives to improve patient outcomes."

This commitment led Blue Cross to set up a collaboration with health care provider groups Equity Action Community (EAC) to address health equity and improve patient health through a team approach as recommended by former U.S. Surgeon General Adams. Provider organizations in the EAC have been able to spot inequities in health outcomes, like high blood pressure, and then move to identify the root causes of the problem. Dr Elizabeth Molina Ortiz, internist and Chair of Atrius Health Equity committee said, "We identified a persistent trend of our White patients reaching their blood pressure goals at a higher percentage than our Black patients." Atrius Health would not have known this trend without racial and ethnicity demographic information about their patients. This sentiment is echoed by Dr. Fernandez who talks passionately about the relationship between primary care provider and patient. Primary care providers are by no means perfect, but equity champion Dr. Fernandez is clear that training doctors to have an "alertness of the physical and spiritual presence of their patients in the room" is powerful. While this relationship is foundational to our health care systems it requires the whole team; nurses, clinicians, and front desk staff to build relationships of trust. Coupled with the power of data, Dr. Fernandez further explains these metrics help her team look at patient populations not only by race and ethnicity but also by language, and zip codes "these results help us understand where we are doing well, and where we are not doing well." Their team has also been able to distribute blood pressure cuffs to patients along with proper training so that they may have more autonomy in their care.

Similarly, data allowed Atrius, with the support of Blue Cross, to meet individualized patient needs with game changing interventions like telehealth appointments to eliminate transportation challenges and providing blood pressure cuffs for use at home for their uncontrolled high blood pressure patients.

We can all start to take control of high blood pressure by working with our doctors and clinicians. Contact your health insurance provider — research and know your benefits and/or reimbursements to take classes for nutrition, weight loss, and to stay active. Find out what resources they offer for prevention and/or treatment, for example you can use a blood pressure cuff at home to monitor your own blood pressure; some physicians can track your blood pressure numbers electronically through technology. You can also measure your blood pressure regularly at a local pharmacy. Stay connected and collaborate with your doctor around medication usage. Patient involvement in a partnership with their health care providers translates to positive health outcomes. Dr Leonor Fernandez, Health Equity Medical Director at BILH enthusiastically shares that "treatment of hypertension is a success story … if we are able to engage our patients."

John Singleton's family wished he did not secretly struggle with hypertension. They wished, just like the characters he brought to life on screen, that he would have chosen to live differently. While the numbers let us know that hypertension is a reality for most African Americans, the use of blood pressure cuffs at home, medications, and effective partnerships with trusted physicians will save lives.

How To Recognize Normal Versus High Blood Pressure

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FOR RELEASE WEEK OF AUG. 19, 2024 (COL. 2)

BYLINE: By Keith Roach, M.D.

TITLE: How to recognize normal versus high blood pressure

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DEAR DR. ROACH: I have been confused about what normal blood pressure is for me (or anyone). I know there are some issues on what normal is today, but let us say that normal is 120/80 mm Hg. Does this mean that 110/90 mm Hg, 130/70 mm Hg, or 150/50 mm Hg is also normal? Is there any significance of the ratio of systolic/diastolic blood pressure? -- L.P.

ANSWER: Because so many people have high blood pressure, and the consequences of untreated or poorly treated high blood pressure include a risk for heart attack and stroke, it's critically important to understand this thoroughly.

For a young, healthy person, the lower the blood pressure, the lower the risk of blood vessel damage that leads to these dreaded complications of heart attack and stroke. I routinely see people with blood pressures of 90/60 mm Hg who are just fine (although they are a bit more likely to faint).

But for middle-aged and older people, we define normal blood pressure as when the systolic (first or top number) pressure is less than 120 mm Hg and the diastolic (the second or bottom number) is less than 80 mm Hg. Elevated blood pressure is when the systolic pressure is between 120-129 mm Hg and the diastolic pressure is less than 80 mm Hg. It's considered hypertension when the systolic number is 130 mm Hg or greater, or the diastolic number is 80 mm Hg or greater. So, all of the readings you proposed are hypertension, not just elevated blood pressure.

Of course, the higher the reading (in general), the higher the risk of damage to the blood vessels, and after some years, the higher the risk of heart attack or stroke. It's not the ratio of the systolic and diastolic numbers that is of interest; it's the difference between them (also called the pulse pressure). So, with the numbers you gave, the pulse pressures are 20, 60 and 100. Independent of blood pressure levels, a higher pulse pressure confers additional risk to the person, mostly because very stiff blood vessels cause a high pulse pressure. Different types of blood pressure medicines affect pulse pressure differently.

DEAR DR. ROACH: Is a platelet count of 135,000 low or in the normal range for a 76-year-old male in good health with no signs of abnormal bruising or bleeding? -- P.R.

ANSWER: The normal range for a platelet count is 150,000-450,000 per microliter, so 135,000 is just below the lower limit of normal. However, it's quite rare to have abnormal bleeding with a platelet count like this, even under stress like a surgical procedure. About 2.5% of the healthy population will have a platelet count below 150,000, so a level of 135,000 may not represent disease at all. Typically, the risk of spontaneous major bleeding becomes high when platelet levels drop below 30,000.

The most common cause of low platelets in older adults is an immune-mediated condition called "immune thrombocytopenia," but there are many possible causes, including medications, bone marrow diseases, and liver disease. For a 76-year-old, if repeat blood counts show that the platelet count is stable in the 100,000 range, most experts would not do further testing in absence of any symptoms.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2024 North America Syndicate Inc.

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Common Causes Of High Blood Pressure Everyone Needs To Know

High blood pressure, or hypertension, is a widespread health issue affecting millions of people worldwide. It's a condition where the force of blood against the walls of the arteries is consistently too high, which can lead to serious health problems like heart disease and stroke.

But what causes high blood pressure? Let's explore some of the common factors and what research tells us about them.

One major cause of high blood pressure is genetics. If your parents or close relatives have high blood pressure, you're more likely to develop it too. This is because certain genes that regulate blood pressure can be passed down through families.

Studies have identified several genetic markers linked to high blood pressure, which helps doctors understand why some people are more at risk.

However, having a family history of high blood pressure doesn't mean you're destined to have it. Lifestyle choices still play a significant role in managing your risk.

Diet is another critical factor. Consuming too much salt is one of the leading dietary causes of high blood pressure. Salt makes the body hold onto extra water, which increases the volume of blood, and subsequently the pressure in the arteries.

Many processed and packaged foods contain high levels of salt, so it's important to read labels and choose lower-sodium options. On the other hand, a diet rich in fruits, vegetables, whole grains, and lean proteins can help manage blood pressure.

The DASH diet (Dietary Approaches to Stop Hypertension) is specifically designed to combat high blood pressure and has been shown to be very effective in research studies.

Being overweight or obese also increases the risk of high blood pressure. Extra weight means the heart has to work harder to pump blood around the body, which can raise blood pressure.

Research has shown that losing even a small amount of weight can significantly reduce blood pressure in people who are overweight.

Regular physical activity is key to weight management and overall heart health. Exercise helps the heart use oxygen more efficiently, reducing the effort needed to pump blood and lowering blood pressure.

Stress is another contributor to high blood pressure. When you're stressed, your body produces hormones that temporarily increase blood pressure by causing your heart to beat faster and your blood vessels to narrow.

Chronic stress can lead to long-term high blood pressure. Finding ways to manage stress, such as through relaxation techniques, exercise, or hobbies, can have a positive impact on your blood pressure.

Smoking and alcohol consumption are lifestyle factors that can cause high blood pressure. The chemicals in tobacco can damage the lining of your artery walls, causing them to narrow and increase blood pressure. Similarly, excessive alcohol intake can raise blood pressure.

However, moderate alcohol consumption has been shown to have some protective effects on the heart. The key is moderation – no more than one drink per day for women and two for men.

Certain medical conditions and medications can also lead to high blood pressure. For example, conditions like diabetes and kidney disease can affect the body's ability to regulate blood pressure.

Some medications, such as birth control pills, cold medications, and pain relievers, can also increase blood pressure. If you have a condition or are taking medication that affects your blood pressure, it's important to work with your doctor to manage these risks.

Age and race are additional factors that influence blood pressure. As people age, their blood vessels naturally lose some of their elasticity, which can increase blood pressure.

Research also shows that high blood pressure is more common in African Americans, who tend to develop it at a younger age and have more severe complications.

In conclusion, high blood pressure is a complex condition with multiple causes, including genetics, diet, weight, stress, lifestyle choices, medical conditions, and age.

Understanding these factors can help you take steps to manage your blood pressure and reduce your risk of related health problems.

By making healthier choices and working with your healthcare provider, you can keep your blood pressure under control and protect your overall health.

If you care about high blood pressure, please read studies about potatoes and high blood pressure, and top 10 choices for a blood pressure-friendly diet

For more information about high blood pressure, please see recent studies about impact of vitamins on high blood pressure you need to know, and the powerful link between high blood pressure and a potassium-rich diet.

Copyright © 2024 Knowridge Science Report. All rights reserved.

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